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Year 3 Repro (JK) > Menopause and secondary amenorrhoea > Flashcards

Menopause and secondary amenorrhoea Flashcards

1
Q

average age of menopause

A

51

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2
Q

How long does the perimenopause usually last?

A

5 years before the menopause

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3
Q

What is known as premature menopause?

A

40 or less

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4
Q

Cause of menopause

A

ovarian insufficiency - oestradiol falls and FSH rises

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5
Q

Other source of oestradiol in ovarian sufficiency with menopause

A

peripheral conversion of adrenal androgens in fat

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6
Q

What may bring on menopause?

A

oophorectomy, chemo, radiotherapy

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7
Q

symptoms of menopause

A 
vasomotor - hot flushes 
vaginal dryness and soreness 
mood change and poor memory
low libido 
muscle and joint pains
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8
Q

Risk factors of osteoporosis

A

thin, Caucasian, smokers, alcohol, positive FH, amenorrhoea, malabsorption, steroids, hyperthyroid

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9
Q

Prevention and treatment of osteoporosis

A

calcium, Vit D, bisphosphonates, exercise, HRT, teriparatide, denosumab monoclonal ab

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10
Q

Local treatment of menopause symptoms

A

vaginal oestrogen pessary/ring/cream

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11
Q

Systemic HRT

A

oestrogen only if no uterus

oestrogen and progestogen if uterus present

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12
Q

Advantage of transdermal systemic HRT

A

avoids first pass so less risk of VTE

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13
Q

What types of oestrogen and progestogen HRT is there?

A

progestogen oral, transdermal or LNG IUS

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14
Q

CI to HRT

A

current hormone dependent breast or endometrial ca
current active liver disease
un investigated abnormal bleeding

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15
Q

What things should you seek advice on before starting someone on HRT?

A

previous VTE, thrombophilia or FH of VTE

previous breast or endometrial ca

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16
Q

2 methods of combined E+P HRT

A

cyclical or continuous

17
Q

cyclical combined HRT

A

14 days E and 14 days E+P

withdrawl bleed

18
Q

Who would you use cyclical combined HRT in?

A

still some ovarian function eg perimenopause

19
Q

continuous combined HRT

A

28 days E+P

20
Q

who would you use continuous combined HRT in?

A

no ovarian function eg >1 year after menopause

21
Q

SERMS

A

E effect on some selected organs eg tibolone

22
Q

Are antidepressants helpful with menopause symptoms?

A

no

23
Q

Natural methods for menopause symptoms

A

phytoestrogen/herbs eg red clover/hypnotherapy/exercise/CBT

24
Q

Benefits of HRT

A

vasomotor
local genital symptoms
osteoporosis

25
Q

Risk of HRT

A

breast cancer if combined HRT
ovarian cancer
VTE, CVA

26
Q

How often to review HRT for vasomotor symptoms

A

annually

27
Q

What age do benefits of HRT outweigh the risks for ovarian insufficiency?

A

50

28
Q

treatment for osteoporosis and vaginal dryness

A

bisphosphonates

vaginal oestrogen

29
Q

Andropause

A

testosterone falls by 1% every year after 30 and DHEA falls

fertility remains as it is a gradual change

30
Q

secondary amenorrhoea

A

has had periods in past but none for 6 months

31
Q

causes of secondary amenorrhoea

A 
pregnancy/breastfeeding 
sheehans syndrome - pituitary failure 
contraception - depoprovera 
PCO
thyroid disease/cushingoid etc
early menopause 
raised PRL 
hypothalamic eg weight change, stress 
androgen secreting tumour 
ashermans syndrome - intrauterine adhesions
32
Q

Exams and tests for secondary amenorrhoea

A 
BP, BMI, hirsutism, acne, cushingoid
enlarged clitoris/deep voice
abdominal/bimanual 
pregnancy test and urine dipstick for glucose 
bloods - FSH,LH,PRL,TSH, oestradiol
pelvic USS
33
Q

BMI aim in secondary amenorrhoea

A

20-25

34
Q

Premature ovarian insufficiency

A

HRT until 50

emotional support and check for fragile X

35
Q

Risks associated with PCOS

A

DM, CVS, endometrial hyperplasia

36
Q

PCO

A

small peripheral ovaries, 20% women, common in adolescents

37
Q

PCOS

A

irregular ovulation so irregular cycle
plenty E but increased androgens
underlying insulin resistance

38
Q

Managing PCOS

A

weight/exercise - increases SHBG
anti-androgen eg CHC, spironolactone
endometrial proliferation - CHC, progestogens, mirena IUS
fertility - clomifene/metformin

Year 3 Repro (JK) (33 decks)

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